Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | NH688 | NC |
NPI | 1033881578 |
---|---|
Provider Name | Kaiharah Nixon |
First Address | Charlotte, NC 28227-7849 |
Second Address | Charlotte, NC 28227-7849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2021 |
Last Update Date | 04/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NH688 | MEDICAL WIG PROVIDER (01) | NC |